Mon April 7, 2014

Fort Hood Shooting: No Simple Link To Mental Illness

I'm Michel Martin and this is TELL ME MORE from NPR News. We'd like to start off the program today by reflecting on last week's shooting at Fort Hood, Texas that left four people dead and injured 16 others, many of them seriously. We now know that the shooter was 34-year-old Army Specialist Ivan Lopez.

He reportedly killed three people and seriously injured 16 others when he opened fire at the Texas Army base on Wednesday before turning the gun on himself. We now know that Specialist Lopez was being treated for depression, anxiety and sleeplessness. But at a press conference on Friday, an Army official said Lopez's medical conditions were not the, quote, direct precipitating factor in the incident. Instead, it was more likely an argument over some paperwork. But we wanted to know more about whether and how these mental health issues and how the military addresses them might factor into what happened at Fort Hood.

So we have called Xiomara Sosa who is a veteran of the U.S. Air Force and the Army. She's also a clinical mental health forensic counselor. She's with us from Charleston, South Carolina. Xiomara Sosa, thank you so much for joining us.

XIOMARA SOSA: Thank you for having me.

MARTIN: Also joining us, Ed Dorn. He's former undersecretary of defense for personnel and readiness. Now he's professor of public policy at the University of Texas at Austin. He's with us from member station KUT in Austin. Professor Dorn, thank you so much for joining us once again.

ED DORN: Thank you, Michel.

MARTIN: So, Xiomara, I'm going to start with you because you wrote an editorial about this for Fox News Latino. It's titled "People Link Killing Rampages to PTSD Due to Colossal Misinformation." What kind of misinformation are you talking about?

SOSA: The immediate thing that people tend to - especially when it comes to veterans, if they're involved in these incidents - is to assume that PTSD is the reason why the rampage happens.

And I think that a lot of the negative stigma that goes along with PTSD, which is, you know, people think someone with PTSD is naturally going to have incredible amounts of antisocial behavior, huge violence, some of the killings that have gone in the last few years. So all of that is based on a lot of misinformation.

I - sadly, through the media, and it's just, you know, a lot of information regarding the mental health and physical health issues of our returning service members is not necessarily portrayed accurately in the media as well.

MARTIN: OK. All right, let's turn to Professor Dorn. At first, I guess I just wanted to ask as a person with a very deep background in the whole question of personal issues, as that was your portfolio at the Department of Defense, what was your reaction to this?

DORN: Sadness, of course and a special sadness for the folks at Fort Hood and the surrounding area who had just gone through a mass shooting a few years ago - 2009. But also, an awareness as your previous speaker said, that it's a serious mistake to think that there's a simple causal relationship here, certainly a mistake to think that PTSD is the cause of either of these incidents.

MARTIN: What kinds of things should we be thinking about? I mean, have to note that Specialist Lopez served as a truck driver in Iraq for four months in 2011. He was not directly involved in combat, and that according to military officials. So I think for many people, he doesn't fit the profile of somebody who would - one expect to come back from a combat zone suffering from PTSD. That's just one thing I would think of.

DORN: You'd think that. It's entirely possible that he had a pre-existing condition. Large numbers of people entering the military do. What we really need to focus on are three things. One, we need to acknowledge that whether or not this particular incident was associated with PTSD - posttraumatic stress disorder - that large numbers of our soldiers do have mental health problems, and those need to be addressed forcefully.

I think the services have done a pretty good job the past six or eight years in trying to get a handle on it but have not succeeded quickly. Two other things that we need to keep in mind are, one, human behavior is extraordinarily tough to predict. And second, where there are lots of guns, there is going to be lots of gun violence.

MARTIN: Xiomara, what about you? What other things do you think we should be thinking about when we think about what happened here?

SOSA: I think that, in general, people need to understand that there is a distinct difference between what mental health is and what mental illnesses is. And these terms are sort of thrown about as if they mean the same thing.

And the majority of the time, we're really talking about two different sides of the same coin. There are different levels of how PTSD actually plays out with different people - the coping skills that the individuals have to begin with, the support system that's in place when they come back, the amount of time that is allotted to them to process a lot of these traumatic events. You know, there's the issue of military sexual trauma as well, which is another form of PTSD. And we have millions of people who are diagnosed with these different forms and these different conditions. And overwhelmingly, they do not go out on these killing rampages. And a lot of it is more internalized.

It takes the form of depression. It takes the form of isolation. It takes the form of shutting people out, shutting down and, you know, a lot of times, suicide ideation. But the whole homicidal ideation, that part I think is just sort of blown to such an extreme because when they do happen, it's so tragic. You know, this is the second time for Fort Hood. It's tragic. Meanwhile, my understanding is that this particular individual has not been diagnosed with PTSD. I'm not even sure how that came up because maybe they were evaluating him, as they do with all individuals in the military at this point, you know. They're sort of trying to do some prevention. But to go ahead and say that he has a clinical diagnosis I think is part of that whole misinformation. I do want to say just one more...

MARTIN: Let me just jump in just for a second here. And if you're just joining us, we're speaking with Xiomara Sosa. She's a veteran of the US Air Force and the Army. She's a clinical mental health forensic counselor with us from Charleston, South Carolina. Also joining us, Ed Dorn. He's the former undersecretary of Defense for Personnel and Readiness, now a professor at the LBGA school in the University of Texas at Austin. So, Xiomara, you were going to add something?

SOSA: That - yeah, that as part of the work that I do, a lot of the social chain advocacy stuff, has me in contact with a lot of the grassroots veterans trying to do a lot of, you know, outreach to our vets right now. And families and friends of theirs that are part of my network system have been reaching out to me ever since the event happen. And one in particular is incredibly distraught because she knows the family of this individual.

And they don't understand where any of the prior diagnosis that the military is saying he even had - they have no idea where they're getting that from because none of them were aware of that. And I'm not questioning whether it's accurate or not accurate. It's just that his entire family was unaware of that.

MARTIN: Well, what could one draw from that? I mean, what - and just to mention that you are also the founder and the president of the You Are Strong! Center on Veterans Health and Human Services, which provides health services to veterans and their families.

So what could we draw from that? Could it be that - you're saying that you don't know that the diagnosis exists or that he was secretive about it and didn't share that with his family?

SOSA: Well, I think it's how the gentleman said earlier, that the majority of individuals in general have some sort of pre-existing condition. The majority of us have gone through some sort of life event that has caused us to have a variety of different mental health issues, we just don't name them that.

And in his case, whether he did or whether he didn't, I just want to point out that he spent nine years in the National Guard. He had an exemplary record. He had absolutely nothing in his record for me to be able to tie in to any of these pre-existing conditions. And, again, the Iraq thing - I mean, he spent a year in Sinai. There was nothing that prevented him from, you know, performing his duty and performing his duty well, and then four months in Iraq as the driver.

And, you know, now his friends are telling me - the one woman in particular who's very upset who knows his family is saying that he did complain that he fell. He believed that he had some sort of traumatic brain injury and he wanted the military maybe to do some evaluation on that, but that had not happened. So I don't know, this is just what I'm being told.

MARTIN: I understand. Let me ask Professor Dorn about this. I mean, it does - in any workplace where people are expensively trained and where people are not easily replaced - one can imagine that there is a lot of pressure to keep people on the job.

The question of treatment for any kind of disorder that is not entirely visible - do you feel that the environment is such that people can effectively seek treatment and are they - and is the bar very high for seeing whether they get the kind of diagnosis that would lead them into treatment?

DORN: Mental health issues are stigmatized in the United States. Even in the civilian world we're always reluctant to admit that a relative has a mental health problem. And the stigma is especially strong in the military so one of the things that - because these are supposed to be tough men and women, they're supposed to pull up their socks and get at it and not admit these kinds of weaknesses. One of the very important things that the military has been doing the past several years is trying to destigmatize psychological issues.

Very prominent military leaders have gone out and admitted publicly that they've had problems. The former vice chief of staff of the Army, Pete Chiarelli, made an interesting point about what we call posttraumatic stress disorder. He says we should stop calling it a disorder. People who have been in combat, who have seen people killed, are naturally going to experience stress, it's not a disorder.

So, yes, there's the stigma, it's important that we address the stigma as part of the larger effort to ensure that soldiers get the counseling they need. The important thing that we as civilians can do is simply treat these men and women as we would treat anybody else unless they ask for special assistance with a problem.

SOSA: Right.

MARTIN: Ed Dorn is a former undersecretary of defense for personnel and readiness. He's now a professor of public policy at the University of Texas at Austin. Xiomara Sosa is a veteran of the U.S. Air Force and the Army.

She's a clinical mental health forensic counselor. She's the founder of the You Are Strong! Center on Veterans Health and Human Services. I thank you both so much for bringing your perspective to this important issue.